Thank you for visiting us and welcome to our online enrollment application for the CSA Early Head Start Infant & Toddler Care and Head Start Preschool Programs!  Please complete the following sections to the best of your ability.  We will use this information to help determine your family’s eligibility for services.
Please do not hesitate to contact us at (775) 786-6023 or firstname.lastname@example.org if you have any questions or need help completing the form.
If you have applied for our program previously, you may receive a duplicate message.  This means your family information is already in our system and we will need to update your application by phone.  If this is the case, please proceed here: Returning Family Application.
Please complete this section for the parent/guardian of the child(ren) applying for the program.
If your mailing address is different from your living address, please be sure to un-check the Mailing Address same as Living Address box below.  If your mailing address is the same, leave the box checked.
Is your family currently experiencing a temporary living situation because housing was lost due to loss of employment/income, financial/economic hardship, or similar reasons?  If yes, select yes to the following question.
Please only add an Additional Parent/Guardian if they are living in the same home  AND  related to any of the child applicants by blood, marriage, adoption, or guardianship.  Do not list parents/guardians who are not living in the home.
Are there other adults in the household?
Please complete all fields in this section.  This information helps us to better document your family’s program eligibility which is based on family income and family size.  Add all members living in your household who are related to you and the other parent/guardian by blood, marriage, adoption, or guardianship AND who are supported by your incomes.
In the Number of Parents/Guardians box, select Two Parent Family if you added 2 parent/guardians to this form.  If your household does not have an additional parent/guardian, select One Parent Family.
Use this section to add all children you would like to enroll in the Early Head Start Infant & Toddler Care or Head Start Preschool Program.
Please be sure to let us know of any concerns or additional information you feel we should be aware of for each applicant in the space Is there anything else you want to tell us about your child?  This could be about vision, hearing, speech/language, developmental delays, behavioral concerns, if there is an IEP or IFSP, special family circumstances, etc.
Do you want to apply now for another child in your family?
Are there other children in the family?
By clicking submit below, you state you understand the above notice and you will receive a confirmation e-mail.  A member from our enrollment office will be in contact with you shortly.  Thank you for completing the enrollment application!